jeudi 25 juin 2020

ETUDE RECHERCHE Contacts avec les services de santé au cours de l'année précédant le décès par suicide et conditions prévalentes Une étude à l'échelle nationale

Research paper
Contacts with Health Services During the Year Prior to Suicide Death and Prevalent Conditions A Nationwide Study
a Centre for Epidemiology on Medical Causes of Death (CépiDc-Inserm), Le Kremlin-Bicêtre, France
b Strategy and Research Department, French National Health Insurance, Paris, France
c Centre of Research in Epidemiology and Statistics, Inserm, Villejuif, France
d Université de Paris, Paris, France
e GHU Paris Psychiatrie et Neurosciences, Sainte-Anne hospital, Paris, France
f McGill Group for suicide studies, McGill University, Montréal, Canada
g Nîmes university hospital (CHU), Nîmes, France
h Assistance Publique-Hôpitaux de Paris, Biostatistics and Epidemiology unit, Cochin Hospital, Paris, France
i French National Public Health Agency, Saint-Maurice, France

Journal of Affective Disorders
Volume 274, 1 September 2020, Pages 174-182
Received 12 February 2020, Revised 12 May 2020, Accepted 14 May 2020, Available online 23 May 2020.
Highlights
Contacts with primary care services are frequent in the last weeks prior to suicide Mental and physical conditions are more common among suicide decedents than in the general population General practitioners and emergency rooms should be targeted for suicide preventive interventions Contacts with Health Services During the Year Prior to Suicide Death and Prevalent Conditions: A Nationwide Study
Abstract
Background
This study was designed to describe contacts with health services during the year before suicide death in France, and prevalent mental and physical conditions.
Methods
Data were extracted from the French National Health Data System (SNDS), which comprises comprehensive claims data for inpatient and outpatient care linked to the national causes-of-death registry. Individuals aged ≥15 years who died from suicide in France in 2013-2015 were included. Medical consultations, emergency room visits, and hospitalisations during the year preceding death were collected. Conditions were identified, and standardised prevalence ratios (SPRs) were estimated to compare prevalence rates in suicide decedents with those of the general population.
Results
The study included 19,144 individuals. Overall, 8.5% of suicide decedents consulted a physician or attended an emergency room on the day of death, 34.1% during the week before death, 60.9% during the month before death. Most contacts involved a general practitioner or an emergency room. During the month preceding suicide, 24.4% of individuals were hospitalised at least once. Mental conditions (36.8% of cases) were 7.9-fold more prevalent in suicide decedents than in the general population. The highest SPRs among physical conditions were for liver/pancreatic diseases (SPR=3.3) and epilepsy (SPR=2.7).
Limitations
The study population was restricted to national health insurance general scheme beneficiaries (76% of the population living in France).
Conclusions
Suicide decedents have frequent contacts with general practitioners and emergency departments during the last weeks before death. Improving suicide risk identification and prevention in these somatic healthcare settings is needed.

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